Anest. intenziv. Med. 2015;26(6):319-327

Influence of prophylactic melatonin administration on the incidence of early postoperative delirium in cardiac surgery patientsAnaesthesiology - Original Paper

B. Bilý^1,*, F. Sabol¹, P. Török², P. Artemiou¹, M. Bilecová-Rabajdová³, P. Kolarcik⁴

¹ University of P. J. Safarik in Kosice, Medical Faculty, Dept. of Cardiovascular Surgery, Eastern Slovak Institute for Cardiovascular Diseases, Kosice, Slovakia

² University of P. J. Safarik in Kosice, Medical Faculty, Dept. of Cardiac Anesthesia, Eastern Slovak Institute for Cardiovascular Diseases, Kosice, Slovakia

³ University of P. J. Safarik in Kosice, Medical Faculty, Dept. of Clinical Biochemistry, Slovakia

⁴ University of P. J. Safarik in Kosice, Medical Faculty, Dept. of Public Health, Slovakia

Objective:
Postoperative delirium in cardiac surgery is a severe complication. The circadian rhythm of melatonin secretion has shown to be altered postoperatively. It was hypothesized that by prophylactic supplementation of a substance that is capable of resynchronizing circadian rhythm such as melatonin may be possible to reduce the incidence of postoperative delirium.

Design:
It is prospective interventional clinical study.


Setting:
A specialized institute of tertiary level health care.

Material and methods:
Two consecutive groups (control and melatonin group) of 250 consecutive patients were enrolled. In the melatonin group the patients received orally 5 mg of prophylactic melatonin treatment the evening before surgery and then every evening until postoperative day 3.

Results:
The incidence of the delirium was 8.4% in melatonin group vs. 20.8% in control group (p = 0.001). Predictors of delirium in melatonin group were age (p = 0.001) and higher EuroSCORE II value (p = 0.001). In multivariate analysis of age and EuroSCORE II value (p = 0.014) were predictors of postoperative delirium. By comparing the group together main predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), CPB time (p = 0.001), ACC time (p = 0.008), sufentanil dose (p = 0.001), mechanical ventilation (p = 0.033).

Conclusion:
The administration of melatonin appears to be associated with a significant decrease of postoperative delirium incidence after cardiac surgery and it should be considered in patients scheduled for cardiac surgery.

Keywords: delirium; prevention; melatonin; cardiac surgery

Received: July 1, 2015; Accepted: September 1, 2015; Published: December 1, 2015  Show citation